HomeMy WebLinkAboutMortgage_Otto"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTED�S� Cou snip Year
. FOR DEDUCTION FROM ASSESSED VALUATION
• S�te Fortn 43709IR71 / 6-09)
S,,,� � Presaibed by Oe7a�M of Lorai GovemmeN Fumnce '
M File Mark
wsraucnoNS: F� �� �
To be filed in person w by mai7 wiM the CountyAUditor or Counry Recorder o/ the wunty where the proper+y' bcat�
FiRng Dates: 1) Real Property: Mus7 !te dunng the year for which Ne deduclion is sought �4� � Counry Auditor
2) Mobde / Manuledured Fbmes not assessed as Real Prtiperty: Must file dunrg the fwefve (72) rbdnth
befae Ma�ch 31 ofeach year the deduction is sought GIBSON COUN�Y AU ITC�R �nry Remder
See reverse side for addtional instructmns and quslificafions.
7 /il. �
District Keyrnimber/kgaldesaiption?
� rn � � � ' � � ' J � L
va4ie cf real papertY az d Mortpage / Contrarl i`det
mch i. amnl year Mard� 1. w�rent year
o�.J D (
m. wha16 his I lrer ewG shara OI inteJest7
narne m remtl "a Niemrt than that of appOmnt h�Eiple Deiwr
Reco�d rwmber Page numbel
-po,t. yd5-oa aol� s7
�ness unpaitl az d Mortgage I Contraa hMebieMess unpxid as d b ihe epp�xant ttce sde
Eate o( aOP�� kgal a eQUitade ovme/t
Q ❑ Yes ❑ No
Ii awned vriN mmeo�m other tlian spouse. 4d�ipte WN wfiom
Name u� rt�wtgagea or mntrae sel�e, .
S.1
Address W mort9a9ee or mntrad x0er (nunDei and stree[ rify, smte. arN ZIP oode)
Name W assignee or orirer ovmer or hdder d mor[gage
Pdd2ss ol assynee (numberentl svee4 �Y, s�afe. eM Z/P code)
Oces ePptitant own property in any oNer I( yes. what muniy7
��uy �, i�aa�a r-i .._ _ r-i .,_
couNn nuorton
Drauaan aPWa'� In Cre
perty in QuesSm: Mnua�y AssesseE
aropenr Dae,uaiNassassea
n,�� r� nc ��.
Dr•aiti�eri\To... ab�0
C8P(f 1��0. , : . ..
...5��.
� a�a, �. � �.......
�
20 _ 20 _ 20 20 _ 2p _ 20 _ 20
nawre Co�mb Audhor /� Counry Date (month. daY. Y��
.V
I/ We certify under penalty of perju that Ne above aM foregoing intwmation is true and correct and that Me app6rant �s a resideM of Indiana and
ow�er+fpntraU buyer of Ne afyreme " ed property on date applicatlon is filed. ��
i (n�o�� � Date (manth. daY. Yse�
FWI revtlenc�aGdre'ss of appfaani (num4er antl shee4 �; �ta, anE LP m
l 3�-f (o W lQl h�a`Ff C� C�-. f4C�U
Pelson aurtrof¢eE Dy Auty ezewteC Pou�er o/ Fttomey w Oy IC G7.1-12-0.7
ACtlr�v ot authatre0 pr!•'..on (number aid sbeet, dry, state. an0 ZIP code)
o�e c,�u�, e�y: r�d